NCLEX® QOTD: Left ear pain

Today's NCLEX-RN® question of the day focuses on a nurse who is assessing a patient with left ear pain and purulent drainage, resides in an adult group home, and displays poor hygiene and thinness. The patient has a history of cerebral palsy and requires caregiver assistance for daily activities. Given these observations, what condition should the nurse consider as the most probable cause of the patient's current presentation? Can you figure it out?

The nurse is assessing a patient from an adult group home who presents to an urgent care clinic with left ear pain with purulent drainage. The nurse notices the patient is wearing dirty clothes, smells strongly of urine, and is very thin. The patient has a history of cerebral palsy and requires caregiver support because they are unable to perform activities of daily living independently. Based on these findings, which condition should the nurse suspect is most likely the cause of this patient's presentation?

A. Depression

B. Dependent neglect

C. Physical abuse

D. Financial constraints

Scroll down for the correct answer!

The correct answer to today's NCLEX-RN® Question is...

B. Dependent neglect

Rationale: Dirty clothes and smelling strongly of urine are signs of neglect. The patient is also very thin which could mean food is not being offered routinely. 

Major Takeaway

The nurse should use clinical judgment to analyze cues related to dependent adult abuse and neglect by organizing and correlating the recognized cues to the patient’s clinical presentation. Patients who are dependent adults who present with dirty clothes, smell strongly of urine and are very thin raise suspicion of neglect because these cues show that their basic needs are not being met. Since this patient has licensed caregivers at an adult foster home, the nurse would not be suspicious of depression or financial constraints as reasons for their appearance. Physical abuse is not suspected because the patient has no signs of unexplained physical injury. 

Incorrect answer explanations

A. Depression

Rationale: If the patient were living alone in the community, this presentation could signal depression. However, this patient is under the care of an adult group home where personal care should be performed by a licensed caregiver.

C. Physical abuse

Rationale: The patient does not show any signs of physical injury that would suggest physical abuse. 

D. Financial constraints

Rationale: The patient is under the care of an adult foster home where a licensed caregiver should be assisting the patient with personal hygiene, including ensuring they have clean clothes and is cleaned after episodes of incontinence. If the patient were living independently, their presentation could signal financial constraints.

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